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Facing life (and death) with a plan

by Paul Malley

It's probably the last taboo topic of discussion in America – serious illness and death. Neither is optional, both are certain and yet many people think and behave as though they will be forever young and in the best of health. At some point reality intrudes and a spouse, parent or grandparent suddenly falls seriously ill and can't make or communicate life-and-death medical decisions for themselves. Instead of the calm quiet of a living room, family members must hurriedly gather in the hospital waiting room and decide what the seriously ill or dying person would or wouldn't have wanted. The discussion can no longer be deferred because a health care provider needs a decision, and now.

Who would want to be in such a position? Who would want to put their spouse or adult children in that position?

People have been urged for many years to plan for times of serious illness and death by completing an advance directive, or “living will,” in which you designate the person who will make those decisions when you can't make them for yourself. Almost all 50 states offer advance directive forms – presumably, to enable the process – but these forms are often written in complicated legal and medical terms that few can readily understand. And none of the forms helps foster the difficult but essential discussion that must come before anybody puts anything in writing.

This was the situation the Five Wishes advance directive sought to improve when it was introduced nationally in 1997. It has since become very popular because it approaches a difficult topic in a manner that people can relate to. It broadens the discussion from the purely medical and legal into the areas that people say matter most – personal, spiritual and family issues.

There are at least five good reasons to use Five Wishes:

  • It's easy to use: Five Wishes is written in everyday language, not “legalese” and “medicalese.” You check what you do want, cross out what you don't want and add as much or as little additional direction as you want.
  • It's all-encompassing: You designate the person you want to make health care decisions for you when you can't speak for yourself, and you define and specify the kind of life support treatment you want or don't want. Five Wishes also allows you to establish how comfortable you want to be; how you want people to treat you; and what you want your loved ones to know. You can also change it as your situation or thinking changes.
  • It's a discussion guide: Five Wishes also helps start and structure often difficult discussions about uncomfortable topics. The focus of discussion is on protecting human dignity, comfort and personal, spiritual and family concerns.
  • It's legal: Your completed Five Wishes meets the legal requirements of at least 42 states and the District of Columbia. In those states that have statutorily required language, mandatory warnings and forms, Five Wishes can be attached to give health care providers and others a more complete picture of your desires.
  • It brings peace of mind: When Five Wishes is completed, signed and properly witnessed, you have a plan. When you share it with your physician, health care agent, family members and others, everybody's on the same page. Nobody has to guess and second-guess because you've already clearly stated your wishes. Guilty feelings and stressful family conflict are avoided.

Five Wishes has helped drive change within society so that those who are seriously ill or near death have their wishes known and respected. Many physicians, hospitals, health systems and hospices now use Five Wishes. Places of worship, attorneys, financial planners, businesses and organizations of all sizes are also among the 35,000 partner organizations that have distributed more than 18 million copies of Five Wishes nationwide. The document is available in 26 languages and in Braille.

For more information about Five Wishes, go to or call (888) 5-WISHES. Spare your loved ones the difficult task of making crucial life and death decisions without knowing what you want. Show your love for them by planning ahead.

(Paul Malley is President, Aging with Dignity, a national non-profit organization that created and distributes Five Wishes.)

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